Some views on being human and being human in therapy.

Dr. Klein, 1/28/2018

Something that consistently strikes me when I speak with patients for five minutes or five years in therapy or psychoanalysis is the sense of innate albeit unformulated or pre-reflective, original knowledge of organizing principles people have of themselves. There was a renown psychoanalyst in San Francisco, Joseph Weiss, who began to see that people had unconscious plans for how they needed to develop in therapy, and that therapists generally did better work if they were able to be sensitive and responsive to the complexities of those plans.

Take, for example, a person who has been treated by her parents while growing up as someone who was somehow always doing something wrong, and made to feel shameful about strivings to be independent. I use the phrase “made to feel” because relationships organize psychic structures, especially when we are young. If this person entered into therapy, the therapist might find that she is generally retiring and shy, with moments of brashness or subtle attempts to push back and to not be such a good girl, as it were.

Perhaps she misses a session out of the blue, lapses on her payment, or tells the therapist something factually inaccurate in her recounting of an interaction they had sessions back. These may all be unconscious tests used to determine whether she can safely utilize the therapist for her development through her earliest and most vital goals….the development of an autonomous and non-shameful sense of herself where she can be separate and imperfect while remaining accepted and loved. Does the therapist fail, or pass, or a combination of the two? What does the therapist bring in from her or his personal development that affects the responsiveness to these encounters? And, how do the two people talk about such complex unfolding processes? Well, it depends! It depends on how the two relate, how safe each feel with one another to be bold and vulnerable, and how the therapist may even fail these tests but remain helpful through admitting the failures; in so doing provide a new relational experience for the patient.

Perhaps when the patient missed that random session the therapist asks about it, or doesn’t at all. Not even talking about it may be helpful for this person or may indicate a shame-inducing response from the therapist. It’s impossible to tell in a hypothetical. The patient’s affect, her emotional expressions tied to verbalized content is the best path to intuiting what may bear the most fruit to inquire about. Perhaps the therapist makes a supportive interpretation, “I can imagine that missing the session may be hard for you to talk about, as you were made to feel guilty about being separate or imperfect growing up.” In making such a statement the therapist is demonstrating a willingness to venture forth and talk about that which has been buried, is being vulnerable in positing something without necessarily requiring the patient to go first, and is also presenting the statement tentatively – leaving room for the patient to correct the record. Again, these are all things she may not have been afforded in her development.

Now, if the therapist were to shame the patient by reminding her that missed sessions carry a fee (I trust that people to know this on their own and do not need reminding) or appears stern and clearly brittle, the patient may become less bold and daring in her attempts to continue her development of autonomy and independence, at least with that therapist at that time, because she would intuit that those aspirations are not welcomed. Or, if the therapist fails as first, the patient becomes introverted, and then the therapist notices this change in emotional expression and says “You know, I think I was a bit shaming there about the missed session. I didn’t mean to be, but I think I missed the point of the missed session for you. You are trying your best to find out if you can be imperfect for me, and if you can do things that are not necessarily pleasing for me and whether I will still be here for you without shaming you like your mother and father did when you were not perfect or submissive for them. Is that somewhere close to what just happened between us?” In this way the therapist can both fail and pass, and that redemptive combination can be even more powerful in terms of growth for both the patient and the analytic couple than anything.

This way of working rests on the assumption that people have internal working models of relationships; of self-concepts that are implicitly incorporated from their life development. Some of these are painful and people are trying to find the safest ways possible to change these so-called pathogenic beliefs. “Safe” here means the best chance of surveying whether one can move a little in the direction that they both crave and fear without eliciting the familiar painful reactions that were experienced from parents, siblings, spouses, and now from themselves.

The reason this approach is somewhat unique, is that is places affectivity (emotional resonance within and between people) as the prime element of internal and interpersonal worlds of experience. Classical analysts and the cadre of what are known as ego-psychologists believe the prime motivators of human volition are sexual and aggressive drives that operate as internal and energic. I disagree, although I do believe those impulses are importantly involved in human experiences in some way that is uniquely determined by each person.  Other schools of analysis have adopted some sensitivity to an interpersonal or contextual world. Cognitive Behavioral Therapists don’t acknowledge any complex worlds of experience based in contextual development at all! They simply believe that you have illogical thoughts, and that you need to learn more logical thoughts! Try telling that to a young attorney who grew up with an abusive father who screamed at him and threatened him. Try telling him that the anxiety that he feels when he goes up against the opposing counsel in trial is just “irrational” and that he should just remember everything will work out fine.

Another reason my approach is somewhat unique is that it imbues human life with a core sense of non-verbalized or non-conscious or pre-reflective knowledge about oneself. I believe, and Joseph Weiss’s research provided empirical support for the notion that people come in to therapy with unconscious tests they need to work through with the therapist, and that the therapist would do best by the patient by trying to help notice and articulate the meaningfulness of those beliefs and tests as they are unfolding, without engaging with the patient as if there is something wrong with them for trying to use us for an unmet developmental need.

In summary, I am an intersubjective and relational psychoanalyst who believes that the essence of psychotherapy is anchored in the dialogic articulation of ever changing and overlapping worlds of experience between the patient and therapist. This approach may be something you are interested in and want to pursue. And true to my ethos, we would have to co-discover whether our talking together proves meaningful and worthwhile for you.  

Thanks for reading my post. I am very happy to be getting to know the people of Portland, Oregon, and I hope you will consider me as a contributing member of the community.

Sincerely,

Lucas A. Klein, Ph.D.

Appointments: (503) 208-7881

NW and SW Downtown Portland.

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March, 2018 

Seeking Psychotherapy and Psychoanalysis

I listen to the struggles involved in life with more than just a focus on symptoms. You may be struggling with depression, anxiety, sleep disturbance, trauma, relationship problems, career or job difficulty, and more. All of these are reasons to seek therapy, and each have underlying causes.

I would like to demonstrate below how I think about a particular aspect of living so that you can get an idea of what I am like and whether you would like to call. If you do want to schedule an appointment, I usually recommend that we set just an initial meeting where you simply come in to see how it goes and whether the experience is such that you believe scheduling a second appointment is in your best interest.  

Inherent in life itself is a sense of angst and for many, a traumatic experience. What most of us think of when we hear the word “trauma” is post traumatic stress disorder. I would encourage you to consider something different. First, there is never a “post” trauma, because one aspect of trauma is that it “destroys time” (Stolorow, 2011), and one is recurrently experiencing the traumatic state in present time. Hence, one’s sense of self in time and space becomes vague and less grounded in the midst of a traumatic period. The idea that treatment should move someone “past” trauma or “resolve” it often unfortunately causes therapists to treat patients as though the thoughts and feelings that form the traumatic re-experiencing need to be vanquished. I have seen that type of treatment leave patients feeling alone with their trauma. My way of being in therapy involved dwelling as deeply as I can in a person’s traumatic experience, and my hope is to form a relational home where those experiences can be organized and rendered comprehensible between us. This form of treatment helps people feel connected in the world again, which is needed to counteract the dissociation that often comes as a reaction to traumatic experience, depression, loss, and more. 

Second, I think the word “disorder” is a misnomer. Trauma is so ubiquitous and a part of human existence that labeling it as a disorder likely merely indicates our social unease in knowing somewhere inside that any of us can be or have already been thrown into a traumatic experience. Third, most people usually think of a narrow range of experiences that qualify as traumatic, such as war time tragedy or assaults. These incidents are of course tragic and important consider in the range of experiences; moreover, in my view there are innumerable situations that beget traumatic dissociation and what follows as self-protection through life. It is the costs associated with the ways you have kept yourself safe in the wake of overwhelming emotional experience that form vexing relational patterns or mood disturbances. 

For instance, a traumatic experience can be growing up with a fragile parent who could not endure separateness or autonomy. In order to maintain the attachment that a child needs to have to a parent, the child may comply and become essentially a part of the parent’s inventory of needs, relinquishing independence. There is nothing wrong with the child for doing this. He or she needs to have a connection to the parent, and it is clear in this situation that it is not safe to be separate, or the parent will perish (or so the message is portrayed by the parent). The implicit meaning for the child may be that the self exists for someone else entirely, and that the child is not safe to act on his or her own behalf. This, I would argue, is a form of relational trauma over a long span of time in development. This child may turn into an adult who now lives a life with markers of having survived that protracted trauma. This may include the development of relationships where he or she has a partner who does not allow for separateness (an unconscious repetition). This person may also have healthy relationships that allow independence and autonomy, but which cause internal guilt…as the child was not free to have such things growing up. Symptoms of depression and anxiety may be intertwined with these complications, and that person may seek therapy as a result. 

I believe people need to feel safe enough to venture forward in life in a way where they can do things that help them move past old ways of being that have been the cause of so much pain. That requisite safety is known through a relationship with someone else, or is torn down by the same. Relationships are the organizers of the mind, which is why we are so moved and affected by the so called past.  Our pasts are of course playing out in real time between ourselves and others as we demonstrate to and with others how we have been shaped by being and time. Our unconscious organizing principles that were fashioned to help us understand emotional experience were learned in early development in order to protect us from disconnection, and symptoms and problems are often a reflection of unconscious efforts to feel cohesive as a self and to remain connected to loved ones.

Talking with me may help you relieve the tolls involved in the way you now live your life. If you would like to schedule, please call or email. I usually return calls within the same day or the next.

(503) 208-7881      LK   at    drkleinpsychology.com